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216 Cards in this Set
- Front
- Back
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B27 associations
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psoriatic arthritis
ankylosing spondylitis IBD Reiter's syndrome |
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B8 associations
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Grave's disease
Celiac sprue |
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DR2
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MS
SLE Goodpastures |
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DR3
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TIDM
Sjogren's |
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DR4
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TIDM
Rheumatoid arthritis |
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DR5
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Hashimoto's thyroiditis
Pernicious anemia |
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Bugs that can vary their antigens
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Borrelia recurrentis
Neisseria gonnorhea Salmonella Trypanosomes |
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Th cell surf markers
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TCR
CD3 CD4 CD28 CD40L CTLA-4 |
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CTL cell surf markers
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CD3
CD8 TCR |
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B cell surf markers
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CD19
CD20 MHC II IgM IgD B7 CD40 CR2 |
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Macrophage cell surf markers
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CD14
MHC II CR1 FcR B7 |
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NKT cells
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CD16
CD56 MHC I receptor |
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IL-3
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Secreted by activated Th cells
Similar to GM-CSF |
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IL-6
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Secreted by Th and macrophages
Stims acute phase reactant |
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IL-10
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Secreted by Th2 cells
Stims Th2 cells & inhibs Th1 cells |
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X-linked immune deficiencies
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Bruton's
CGD Wiskott-Aldrich |
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Causes of SCID
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ADA deficiency
Failure of IL-2 receptor Failure to transduce pre-TCR signal |
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Hyper-IgM syndrome
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Defect in CD40L > can't class switch
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Wiskott-Aldrich syndrome
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Infections
Thryombocytopenic purpura Eczema Malignant lymphoma X-linked IgM can't respond to capsular polysacharides |
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Job's syndrome
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Can't make IFN-gamma
Cold abscesses, retained primary teath IgE |
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LAD I
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Can't adhere
Severe pyogenic infections Delayed umbilical separation |
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LAD II
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Can't roll
Severe pyogenic infections Delayed umbilical separation |
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Chediak-Higashi syndrome
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Microtubule defect > lysosomal emptying problems > large granules
Recurrent pyogenic infections Albinism Periph neuropathy |
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Acute rejection cause`
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T cell
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Chronic rejection
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Antibodies > fibrinoid necrosis
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Pharmacokinetics:
Half life equation |
t(1/2) = .7 * Vd/CL
Four half-lives = 93% change |
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Pharmacokinetics:
Maintenance dose |
Md = ([X]p * Cl) / B
Adjust for renal/hepatic dysfunction |
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Pharmacokinetics:
Loading dose |
LD = ([X]p * Vd) / B
Unchanged in renal/hepatic failure |
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Pharmacokinetics:
Volume of distribution |
Vd = Dose / [X]p
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Drugs with zero-order metabolism
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Phenytoin, ethanol, high-dose aspirin
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MAC
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Minimal anesthetic concentration. Increases with decreasing potency/decr lipid solubility of agent
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Methoxyflurane & toxicity
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Inhaled general anesthetic
Nephrotox |
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Ketamine
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Dissociative injectable anesthetic. Cardiovascular stim
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Rapid acting benzo
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Midazolam
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Rapid acting barbiturate
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thiopental
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Propofol
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IV general anesthetic
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Vesamicol
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Blocks ACh transport into vesicles
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Reserpine
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Blocks NE transport into vesicles
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Hemicholinium
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Blocks choline (RLS) into cells for ACh synth
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Drugs:
Hexamethonium |
Ganglionic (Nn) blocker
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Drugs:
Anti-cholinergic toxicity |
Red as a beet
Blind as a bat Dry as a bone Hot as hell Fast as a hare Mad as a hatter |
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Drugs:
Cholinesterase poisoning |
Salivation
Lacrimation Urination Defecation Bradycardia Bronchospasm Miosis Sweating |
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Drugs:
Isoproterenol |
Non-selective beta agonist
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Drugs:
Pheylephrine |
a1 agonist
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Drugs:
Xylometzolone |
a1 agonist > nasal decongestant
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Drugs:
B1 selective beta blockers |
Metoprolol, esmolol, atenolol, acebutalol
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Drugs:
Timolol |
Non-selective beta blocker for glaucoma
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Drugs:
Beta blocker/partial agonists |
PAL:
Pindolol Acebutalol Labetalol |
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Drugs:
Non-selective beta blockers |
Propanolol, timolol, nadolol, pindolol
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Drug side effects:
Gynecomastia |
Spironolactone
Cimetidine Alcohol Ketokonazole |
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Drug side effects:
Acute cholestatic hepatitis |
Macrolides
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Drug side effects:
Acute Fanconi syndrome |
Expired tetracycline
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Drug side effects:
Aplastic anemia |
Chloramphenicol
Benzene NSAIDs |
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Drug side effects:
Agranulocytosis |
Clozapine
Carbamazepine Colchicine |
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Drug side effects:
Massive hepatic necrosis |
Halothane
Valproic acid Acetominophen |
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Drug side effects:
Photosensitivity |
Sulfonamides
Amiodarone Tetracycline |
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Drug side effects:
Lowered seizure threshold |
Buproprion, imipenem/cilastin
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Drug side effects:
P450 inhibitors |
INH
Sulfonamides Cimetidine Ketoconazole Erythromycin Grapefruit |
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Drug side effects:
P450 inducers |
Quinidine
Barbiturates Phenytoin Rifampin Griseofulvin Carbamazepine |
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Major mechanism of BP maintenance in hemorrhage
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Venoconstriction/decr venous capacitance
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Drugs:
Nitroprusside & tox |
Powerful vasodilator
CN and thiocyanate generation Short acting |
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Milrinone
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PDE III inhib
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Amiloride
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Blocks ENaC
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Triamterene
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Blocks ENaC
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Ibutilide
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Blocks K+ channel in heart
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Sotalol
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Blocks K+ channel in heart
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Amiodarone toxicities
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Liver damage
Pulm fibrosis Hypothyroidism Gray skin deposits |
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Minoxidil
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Opens ATP-gated K+ channels in vSMCs
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Hydralazine
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Opens K+ channels in vSMCs
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Cilostazol
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PDE III inhib > incr cAMP > vasodilation for claudication
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Class IA antiarrhythmics
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Quinidine
Procainamide Disopyramide |
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Class IB antiarrhythmics
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Lidocaine
Mexiletine |
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Class IC antiarrhythmics
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Flecainide
Encaidine |
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Class III antiarrhythmics
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Sotalol
Ibutilide |
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Mechanism of toxicity in ADA deficiency
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Excess adenosine salvaged to excess dATP, which inhibs ribonucleotide reductase. Lack of NTPs causes SCID
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DNA polymerase types and functions
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DNA polymerase I: replace RNA primer w/ DNA (5'>3')
DNA polymerase III: 5'>3' synthesis, spell checker, and 3'>5' exonuclease |
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Most abundant RNA type? Made where in the cell? Made by which RNA polymerase?
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rRNA made in nucleolus by RNA pol I
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Smallest RNA type? Made by which RNA polymerase?
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tRNA, RNA pol III
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mRNA is made by which RNA polymearse?
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RNA polymerase II
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Stop codons?
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TAG/UAG
TAA/UAA TGA/UGA |
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Name of protein-coding RNA before processing to mRNA?
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heternogenous nuclear RNA (hnRNA)
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Location of AA binding to tRNA and sequence?
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Amino acid binds to 3' end of tRNA where there is always a 5'CCA sequence
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Names of ribosomal tRNA binding sites
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A: loading site of charged AA-tRNA
P: initial binding site of Met E: empty tRNA |
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Oubain
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Inhibs Na+/K+ ATPase
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Dynein
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Retrograde transport on microtubules, cilia
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Kinesin
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Anterograde transport on microtubules
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Chediak-Higashi syndrome
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Microtubule polymerization/trafficking defect > defective phagolysosomes
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Roles of lecithin
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Lecithin = phosphatidylcholine
In myelin, bile, In surfactant as dipalmitoyl phosphatidylcholine Cholesterol esterification via LCAT |
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Collagen synthesis steps
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1) Ribosome: preprocollagen synth (Gly-X-Y polymer, X & Y =proline and lysine)
2) ER: Hydroxylation of proline in lysine 3) Golgi: Glycosylation & assembly to procollagen trimer 4) Exocytosis 5) Cleavage of overhangs 6) Cross-linking > collagen fibrils |
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Diseases assoc w/ berry aneurysm
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Marfan's
Ehler-Danlos Adult polycystic kidney disease |
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Vimentin
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Connective tissue IHC marker
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Desmin
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Muscle IHC marker
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Aldolase B deficiency
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Fructose intol: cirrhosis/jaundice, hypoglycemia, vomiting
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Galactose-1-phosphate uridyltransferase deficiency
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Galactosemia > Cataracts (galactitol), retarded, HSM
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Acetyl CoA fates
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Acetoacetate > HMG CoA synthase
HMG CoA > HMG CoA lyase >ketones HMG CoA > HMG CoA reductase > mevalonate > cholesterol Acetyl CoA carboxylase > Malonyl CoA > fatty acids Citrate synthase > TCA cycle |
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Regulation of G6P synthesis
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Hexokinase: neg feedback by G6P
Glucokinase: lower Km but higher Vmax. Stim'd by insulin |
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ATP needed for gluconeogenesis to convert two pyruvates into one glucose?
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6 ATP equivalents
Pyruvate carboxylase PEP carboxykinase (GTP) 3PG > BPG |
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Regulators of PFK1?
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Inhibs: ATP, citrate
Stims: F-2,6-BP, AMP |
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Regulators of pyruvate kinase?
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Inhibs: alanine, ATP
Stims: F-1,6-BP |
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Regulators of aKG dehydrogenase?
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Inhibs: ATP, NADH
Stims: ADP |
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Electron transport chain
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NADH>C1 and pumped
FADH2>C2, no H+ pumped CoQ C3, H+ pumped Cytochrome C C4, H+ pumped and e- transferred to O2 C5: ATP synthase uses H+ gradient |
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Oligomycin
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Poisons ETC ATPase > respiration stops b/c H+ build up
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2,4-DNP
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Uncouples ETC by allowing proton leak
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Lipoic acid function
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PDH & aKG dehydrogenase cofactor
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Glutaminase
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Release NH3 from glutamine to make glutamate
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Glutamate dehydrogenase
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Release NH3 from glutamate to make a-KG
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Homocystinuria
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Due to
1) Lack of cystithionine synthase 2) Low B6 affinity of CS 3) Lack of methionine synthase Consequences -Retard -Tall -Lens dislocation -Atherosclerosis>MI/stroke |
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Alkaptonuria cause & consequence
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Homogentisic acid oxidase deficiency
Blackened urine Benign unless severe arthralgias |
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Pompe's disease
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Lack of lysosomal a1,4-glucosidase
-Cardiomyopathy -Cirrhosis -Muscle weakness |
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Cori's disease
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Lack of a1,6-glucosidase debranching enzyme
-Milder version of von Gierke's |
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von Gierke's disease symptoms
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Lactic acidosis
Hypoglycemia (severe) Glycogen in liver/hepatomegaly |
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Hexosaminidase
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Deficient in Tay-Sachs
-GM2 ganglioside accumulates -Cherry red spot -Onion skin lysosomes - |
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X-linked lysosomal storage diseases
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Hunter's disease: iduronate sulfatase (mucopolysacaridase)
Fabry disease: a-galactosidase > ceramide accumulation |
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Glucocerebrosidase
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Gaucher's disease > glucocerebroside accum
-Gaucher cells -Bone crises -Femur neccrosis |
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Sphingomyelinase
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Nieman-Pick disease > HSM, cherry red spot, foamy macrophages
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ApoA, ApoB, ApoC, and ApoE functions
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ApoA: activates LCAT
ApoB: binds LDLR ApoC: LPL cofactor ApoE: remnant uptake |
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LCAT function
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In HDL
Activated by ApoA Esterifies free cholesterol and traps it in the HDL particle |
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CETP function
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Takes cholesterol trapped in HDL by LCAT and transfers it to a VLDL for clearance
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Type I familial dyslipidemia
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Elevated chylomicrons due to decr LPL or ApoC (LPL cofactor)
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Type IIa familial dyslipidemia
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Elevated LDL due to LDLR mutation. Autosomal dominant
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Acute intermittent porphyria
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Lack of uroporphyrinogen I synthase > porphobilinogen accumulation.
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Porphyria symptoms
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abdominal colic
polyneuropathy pink urine psych +/- skin stuff (itching/photosensitivity) |
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Pophyria cutanea tarda
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Accum of uroporphyrinogen III
-Pruritic burning skin -Polyneuropathy -Abd colic -Psych |
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Lead effects
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Inhibs ALA dehydratase & ferrochelatase
-Abd colic -Lead lines on gums and bones -Wrist drop -Basophilic stippling of RBCs -Sideroblastic anemia |
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Ash leaf spots
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Tuberous sclerosis
-Adenoma sebaceum -Renal angiomyolipoma -Cardiac rhadomyomas -Tubers -Seizures -Retardadtion |
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Adenoma sebaceum
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Tuberous sclerosis
-Tubers -Ash leaf spots -Retarded/seizures -Cardiac rhabdomyomas -Renal angiomyolipomas |
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vHL disease
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cavernous hemangiomas
hemangioblastomas renal cell CA (bilateral) chromosome 3 |
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Fragile X symptoms
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-Retardation
-Long jaw -Large testes -Large ears |
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Down's associations
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Acute lymphocytic leukemia
Endocardial cushion defects > septum primum ASD Duodenal atresia |
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Down's serum markers
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Incr hCG
Decr AFP Decr unconj estriol Incr nuchal translucency |
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Patau's syndrome
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Trisomy 13
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Causes and effects of vitamin B6 deficiency
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Pyridoxal phosphate
-INH -OCPs Causes convulsions b/c can't make GABA. Also can't make niacin or degrade homocysteine with cystithionine |
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Causes of vitamin B3 deficiency
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1) Diet lacking both niacin AND tryptophan
2) Hartnup disease 3) Carcinoid syndrome 4) INH causing vit B6 deficiency |
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Periplasmic space
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Between peptidoglycan cell wall & outermembrane in GN bacteria. Houses enzymes, including lactamases
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Bug with no murein in its cell wall
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Chlamydia
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Bug with abnormal capsule?
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Bacillus anthracis
Poly-D glutamate instead of polysacharide |
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Teichoic acid
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GP surface antigen
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Key component of spore wall
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Dipicolinic acid
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Bugs w/ IgA proteases
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Allow colonization of mucosal surfaces by:
S. pneumo Neisseria meningitidis Neisseria gonorrhea Haemophilis influenzae |
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Novobiocin
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Differenitate between coagulase negative GPCs:
Staph epidermidis: sensitive Staph saprophyticus: resistant |
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Bacitracin
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Distinguish between catalase negative beta-hemolytc GPCs (streptococci):
Strep pyogenes (GAS): sensitive Strep agalactiae (GBS): resistant |
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Optochin
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Distinguish between catalase negative, alpha hemolytic GPCs (streptococci)
Sensitive: strep pneumo Resistant: strep viridans |
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Bacterial salt test
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Distinguish between catalase negative, gamma hemolytic GPCs:
Sensitive: Group D strep Resistant: Enterococcus |
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Media for growing gram negatives and distinguish lactose fermentation?
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MacConkey's agar
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Togaviridae
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Rubella
EEE VEE |
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Flaviviridae
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Yellow fever
Dengue HCV West Nile |
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Picornaviridae
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Polio
Echovirus Rhinovirus Coxsackievirus HAV |
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Reoviridae
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Rotavirus
Naked dsRNA virus |
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Paramyxoviridae
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Parainfluenza
RSV Measles Mumps |
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Calicivirus
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HEV
Norwalk |
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Vancomycin toxicities
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Red man syndrome (antihistamines, slow infusion)
Nephrotox Ototox |
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Imipenem toxicity
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Seizures
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Monobactam antibiotic?
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Aztreonam
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Methcillin toxicity?
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Interstitial nephritis
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What antibiotic can't be used with anaerobes and why?
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Aminoglycosides (gentamycin, neomycin, amikacin, tobramycin, streptomycin) b/c need O2 to get into cell
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VACUUM THe BedRoom
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Bugs w/ tetracyclines:
Vibrio Acne (proprionobacterium acnes) Chlamydia Ureaplasma urealyticum Mycoplasma Tularemia H. flu Borrelia Rickettsia |
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Tetracyline class metabolism
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Doxycycline is fecally eliminated so use it for renal patients
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Capsofungin
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Inhibs fungal cell wall synthesis>tx of aspergillosis
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Terbinafine
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Inhibs squalene epoxidase > can't make ergosterol. Used for dermatohytoses b/c accumulates in keratin-containing tissues
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Flucytosine
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Activated by fungi to 5-FU and then inhibs DNA synth by blocking thymidine synthesis
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Azoles
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Inhib ergosterol synthesis. Some too toxic for anything except topical use. Inhib P450. Inhib steroid synthesis >
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Amphoteracin mech and tox
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Mech: binds ergosterol > pores
Tox: shake & bake, nephrotox, arrythmias |
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Amantadine side effects and targets
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Ataxia, slurred speech
Flu Rubella (?) Parkinson's |
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Ribavirin mech, side effects and targets
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Inhibs GMP synthesis
Teratogen Hemolytic anemia RSV, HCV |
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Ganciclovir toxicity
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Pan-myelosuppression
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Day of implantation and what structure implants?
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Blastocyst implants day 6 post-fertilization
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Typical location of blastocyst implantation in uterus?
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Posterior superior wall of uterus
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Week heart begins to beat?
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Week 4
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Diaphragm embrylogolgy
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Pleuroperitoneal folds (dorsal wall)
Dorsal mesoesophagus Septum tranversum (ventral wall) Body wall |
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Reportable diseases?
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B.A. SSSMMART Chicken or you're Gone
HBV HAV Syphilis Salmonella Shigella Measles Mumps AIDS Rubella TB Chickenpox Gonorrhea |
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Malpractice requrements
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3Ds: Dereliction of Duty to Damage
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Mature defense mechs?
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1) Altruism
2) Humor 3) Sublimation 4) Suppression (voluntary) |
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Muscle histology: lines and bands of skeletal muscle
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A band: myosin + actin
I band: actin only H band: myosin only M line: myosin fusion line Z line: inter-sarcomere line |
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Psammomoa bodies
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Papillary thyroid
Serous cystadenocarcinoma (ovary) Meningioma Mesothelioma |
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Orphan Annie nuclei
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Papillary thyroid CA
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Types of thyroid CA
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Papillary
Follicular Anaplastic Medullary |
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Normal EF?
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>55%
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Huntinton's chromosome?
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Chromosome 4
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What percent reduction in area is required for stable/exertional angina? For "stable" angina at rest?
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75% narrowing results in exertional angina
90% narrowing results in angina at rest |
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Interaction with adenosine that inhibits its effect?
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Methylxanthines
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Enzyme that activates pancreatic trypsinogen once it reaches the lumen? And where is it located?
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Enterokinase in the brush border
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Hesselbach's triangle borders and why I care
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Site of direct inguinal hernia
Inferior border: inguinal ligament Lateral border: inferior epigastric Medial border: rectus abdominus |
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Mechanism of prochlorperizine
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D2 antag
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Mechanism of scopalamine
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Anti-cholinergic
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Mechanism of promethazine
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Anti-histamine > motion sickness drug
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Mechanism of metoclopramide
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D2 antag
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Types of diverticuli (pulsion vs. traction)
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Pulsion=false=mucosa herniates through muscularis
Traction=true=all three layers |
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Pyloric stenosis: classic sign of physical exam, timing, and epidemiologic association
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Sign: palpable olive
Timing: 2-4 wks Epi: first-born males |
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Type A gastritis
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Fundal atrophic/autoimmune gastritis. Achlorhydria, gastric CA
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Type B gastritis
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H. pylori. Incr gastrin and incr gastric acid.
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Which IBD has granulomas?
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Crohn's
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Ulcerative colitis manifestations/association outside GI (there are 2)?
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1) Pyoderma gangrenosum
2) Primary sclerosing cholangitis |
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Dimenhydrinate
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Dramamine
Anti-histamine for motion sickness |
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Substance that dilates afferent arteriole?
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Prostaglandins
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Free water clearance
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C(fw) = V - C(osm)
C(fw) = V - [V*U(osm)]/[P(osm)] |
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MUD PILES
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Methanol
Uremia Diabetic ketoacidosis Phenacetin INH/iron Lactic acidosis Ethylene glycol Salicylates |
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Nephrotic syndrome causes in adults vs in children?
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Kids: minimal change
Adults: membranous glomerulonephritis |
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WAGR complex
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Wilms tumor
Aniridia Genitourinary malformations Retardation |
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Pharmacologic therapy for von Willebrand disease?
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ddAVP
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V1 receptor function and mech?
V2 receptor function and mech? |
V1 > Gq > vasoconstriction
V2 > Gs > aquaporins |
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Inhibitor of GH release?
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Somatostatin
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Effects of PTH
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1) Activates osteoclasts via osteoblasts > Ca2+ and phosphate release
2) Incr Ca2+ resorb by kidneys (DCT) > decr urinary Ca2+ 3) Decr phosphate resorb by kidneys (PCT) 4) Incr urinary cAMP and phosphate 5) Incr calcitriol (stims 1a-hydroxylase) |
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Dexamethasone suppression test
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1) Cortisol suppressed by low dose > normal
2) Cortisol suppressed only by high dose > pituitary ACTH-producing tumor 3) Cortisol not suppressed at any dose > cortisol-producing tumor or ectopic ACTH-producing tumor (small cell lung CA paraneoplstic syndrome) |
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Syndromes w/ pheochromocytoma
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MEN II (IIa): w/ medullary thyroid & hyperparathyroid
MEN III (IIb): w/ medullary thyroid, cutaneuous neuromas, & marfanoid habitus Neurofibromatosis vHL |
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Wermer syndrome
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MEN type I: pituitary tumor, parathyroid adenoma/hyperplasia, and pancreatic tumors
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Sipple syndrome
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MEN type II (IIa): Medullary thyroid CA, pheochromocytoma & parathyroid adenoma
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How long does it take to go from spermatogonium to spermatozoon?
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64 days
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Lynch syndrome
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1) HNPCC
2) Ovarian CA 3) Endometrial CA |
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Bernard-Soulier
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Deficiency of GPIb
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Glanzman's
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Deficiency of GPIIb/IIIa
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IL-3 function
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Similar to GM-CSF
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|
|
IL-6 function
|
Stims acute phase reaction
|
|
|
IL-8
|
Chemotactic factor
|
|
|
Site of AML spread
|
Gums
|
|
|
Site of ALL spread
|
CNS & testis (need CNS prophylaxis)
|
|
|
Hairy cell leukemia cell line, serum marker, and treatment?
|
Hairy B cells
Dx: TRAP Rx: 2-chlorodeoxyadenosine |
